Scoliocorrector Fatma-UI for correction of adolescent idiopathic scoliosis: Development, effectivity, safety and functional outcome

BACKGROUND Adolescent idiopathic scoliosis remains a major problem due to its high incidence,high risk,and high cost.One of the aims of the management in scoliosis is to correct the deformity.Many techniques are available to correct scoliosis deformity;however,they are all far from ideal to achieve three-dimensional correction in scoliosis.AIM To develop a set of tools named Scoliocorrector Fatma-UI(SCFUI)to aid threedimensional correction and to evaluate the efficacy,safety,and functional outcome.METHODS This study consists of two stages.In the first stage,we developed the SCFUI and tested it in finite element and biomechanical tests.The second stage was a single-blinded randomized clinical trial to evaluate the SCFUI compared to direct vertebral rotation(DVR).Forty-four subjects with adolescent idiopathic scoliosis were randomly allocated into the DVR group(n=23)and SCFUI group(n=21).Radiological,neurological,and functional outcome was compared between the groups.RESULTS Finite element revealed the maximum stress of the SCFUI components to be between 31.2-252 MPa.Biomechanical analysis revealed the modulus elasticity of SCFUI was 9561324±633277 MPa.Both groups showed improvement in Cobb angle and sagittal profile,however the rotation angle was lower in the SCFUI group(11.59±7.46 vs 18.23±6.39,P=0.001).Neurological and functional outcome were comparable in both groups.CONCLUSION We concluded that SCFUI developed in this study resulted in similar coronal and sagittal but better rotational correction compared to DVR.The safety and functional outcomes were also similar to DVR.

The Outcome of Posterior Spinal Fusion and Instrumentation of Adolescent Idiopathic Scoliosis without Wound Suction Drainage

Background: In spine surgery postoperative closed suction drainage is used to decrease the potential risks of wound hematoma formation, and reduces the risk of infection, cord compression and neurologic deficit. However, the efficacy of drains used for this purpose in adolescent idiopathic scoliosis is controversial. The purpose of this study is to evaluate outcomes of patients after posterior spinal fusion with instrumentation for adolescent idiopathic scoliosis without wound suction drainage. Methods: A total of 66 Patients who underwent posterior spinal fusion and instrumentation for the correction of Adolescent idiopathic scoliosis without the use of drain from January 2012 to January 2021 were included. Wound dehiscence, wound hematoma, infection, preoperative and postoperative hemoglobin levels and need for transfusion were described as frequency and mean values. Results: The average age was 15.06 years. Hospital stay was 2.2 days. Patients were followed-up over 50.21 months. There was no deep infection, wound hematoma. The difference between just postoperative and three days after operation hemoglobin levels was not significant and no need for transfusion. Only 3 (4.5%) cases with superficial skin infection and 4 (6%) cases with skin and Wound dehiscence were treated with dressing and antibiotics with full recovery. Conclusion: Without using drain for patients with idiopathic scoliosis who underwent posterior spinal fusion and instrumentation, no increase in blood loss, transfusion requirements, wound infection, skin dehiscence, and wound hematoma was observed.

Research progress on the safety of nail placement in adolescent idiopathic scoliosis surgery

Adolescent idiopathic scoliosis is a spinal deformity with unknown etiology and high incidence,especially in adolescent females.If scoliosis patients do not get effective treatment in the early stage,the degree of scoliosis will continue to worsen with the growth of age or the rapid development of scoliosis in a short time,and the appearance deformities such as high and low shoulders and razor back will gradually appear,which can affect the cardiopulmonary function and even shorten life expectancy.It has a great impact on the physical and mental health of the patients.Mild scoliosis is often well controlled by bracing,and moderate to severe scoliosis deformity often requires scoliosis corrective surgery.In adolescent idiopathic scoliosis correction,pedicle screws offer better stability and firmness,stronger orthopedic force,and lower incidence of related complications caused by instruments than traditional hook and conical internal fixation instruments.At the same time,scoliosis patients have uneven development of the left and right sides of the vertebral body,narrow diameter of concave pedicle and varying degrees of rotation of parietal vertebra,resulting in changes in the position of important anatomical structures such as spinal cord and thoracic aorta in the spinal canal.It makes it difficult to place pedicle screws,resulting in a high misplacement rate.How to improve the safety of screw placement,reduce the misplacement rate and the risk of spinal cord,nerve root,blood vessels,viscera and so on,has always been the focus of spinal surgeons.This paper summarizes the related literature on the effects of new techniques such as pedicle anatomy,complications of nail placement and computer navigation,and 3D guided template on the accuracy of screw placement in adolescent idiopathic scoliosis patients,and the safety of nail placement.In order to provide reference for clinical practice.

Accuracy of screw placement in the apical region of Lenke 1 adolescent idiopathic scoliosis surgery using a calibration technique for the intraoperative navigation error

Objective:To study the position and the grade of screw perforation in the apical region of adolescent idiopathic scoliosis(AIS)surgery using a calibration technique for the intraoperative navigation error,and to analyze the related factors of navigation deviation and the clinical significance of the calibration technique.Methods:From 2017 to 2020,a total of 60 Lenke 1 AIS surgical cases were enrolled in this research.The 30 cases received surgery using the intraoperative navigation system(Navigation group)and another 30 cases were assisted with intraoperative navigation system with calibration technique(Calibration group)for the intraoperative navigation error.The basic information and radiological data of the both groups were all recorded.According to the Fu Chang-feng’s pedicle channel classification system,the pedicle on the apical region of the two groups was classified.And then the accuracy of screw placement of the two groups was evaluated according to the Rao’s classification.Results:A total of 600 screws were placed in the two groups.The 297 and 303 pedicle screws were implanted in the navigation group and the calibration group,respectively.In the apical region of the calibration group,the rates of the grade 0 screw placement in type A,B and C pedicle were 95.7%,86.7%and 68.9%respectively.It was a statistically significant difference from the 73.9%,66.9%and 30.0%in the navigation group respectively(P<0.05).In the calibration group,the rates of the medial cortical perforation in the type A,B,C and D pedicle were 0%,1.6%,1.6%and 0%,respectively.The corresponding rates were 16.3%,16.9%,30.0%and 47.6%in the navigation group,respectively.Moreover,in the concave side of the apical region of the calibration group,the rates of the medial cortical perforation in the type A,B,C and D pedicle were 0%,3.6%,2.6%and 0%,respectively.Compared with the calibration group,the corresponding rates were higher in the navigation group(34.4%,25.9%,37.2%and 60.0%,respectively).No serious complications such as spinal cord or neurovascular injury occurred for the two groups.Conclusion:Compared with the intraoperative navigation system,the calibration technique for the intraoperative navigation error could provide the higher accuracy of pedicle screw placement in the apical region of the major curve,the lower medial cortical perforation rate,the less screws misplacement rate on the concave side and the less complication rate of the severe Lenke 1 AIS patients.

Posterior Selective Thoracic Fusion in Adolescent Idiopathic Scoliosis Patients:a Comparison of All Pedicle Screws versus Hybrid Instrumentation

Objective To analyze the influence of segmental pedicle screws versus hybrid instrumentation on the correction results in adolescent idiopathic scoliosis patients undergoing posterior selective thoracic fusion. Methods By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients who underwent selective thoracic fusion from February 2000 to January 2007 in our hospital, the patients were divided into 2 groups according to different instrumentation fashions： Group A was hook-screw-rod （hybrid） internal fixation type, Group B was screw-rod （all pedicle screws） internal fixation type, and the screws were used in every segment on the concave side of the thoracic curve. The parameters of the scoliosis were measured and the correction results were analyzed. Results Totally, 48 patients （7 males, 41 females） were included, with an average age of 14.4 years old and a mean follow-up time of 12.3 months. Thirty and 18 patients were assigned to group A and group B, respectively. The mean preoperative coronal Cobb angles of the thoracic curve were 48.8° and 47.4°, respectively. After surgery, they were corrected to 13.7° and 6.8°, respectively. At final follow-up, they were 17.0° and 9.5°, with an average correction rate of 64.6% and 79.0%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The mean preoperative coronal Cobb angles of the lumbar curve were 32.6° and 35.2°, respectively. After surgery, they were corrected to 8.6° and 8.3°, respectively. At final follow-up, they were 10.3° and 11.1°, with an average correction rate of 66.8% and 69.9%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The correction loss of the thoracic curve and lumbar curve in the 2 groups were 3.1° and 1.8°, 2.4° and 2.4°, respectively. No significant difference was noted （both P〉0.05）. The decompensation rate at final follow-up in these 2 groups were 4% （1/25） and 7.1% （1/14） respectively, with no significant difference （P〉0.05）.

Predictors of spine deformity progression in adolescent idiopathic scoliosis: A systematic review with meta-analysis

AIM: To evaluate published data on the predictors of progressive adolescent idiopathic scoliosis(AIS) in order to evaluate their efficacy and level of evidence. METHODS: Selection criteria:(1) study design: randomized controlled clinical trials, prospective cohort studies and case series, retrospective comparative and none comparative studies;(2) participants: adolescents with AIS aged from 10 to 20 years; and(3) treatment: observation, bracing, and other. Search method: Ovid MEDLINE, Embase, the Cochrane Library, Pub Medand patent data bases. All years through August 2014 were included. Data were collected that showed an association between the studied characteristics and the progression of AIS or the severity of the spine deformity. Odds ratio(OR), sensitivity, specificity, positive and negative predictive values were also collected. A metaanalysis was performed to evaluate the pooled OR and predictive values, if more than 1 study presented a result. The GRADE approach was applied to evaluate the level of evidence.RESULTS: The review included 25 studies. All studies showed statistically significant or borderline association between severity or progression of AIS with the following characteristics:(1) An increase of the Cobb angle or axial rotation during brace treatment;(2) decrease of the rib-vertebral angle at the apical level of the convex side during brace treatment;(3) initial Cobb angle severity(> 25o);(4) osteopenia;(5) patient age < 13 years at diagnosis;(6) premenarche status;(7) skeletal immaturity;(8) thoracic deformity;(9) brain stem vestibular dysfunction; and(10) multiple indices combining radiographic, demographic, and physiologic characteristics. Single nucleotide polymorphisms of the following genes:(1) calmodulin 1;(2) estrogen receptor 1;(3) tryptophan hydroxylase 1;(3) insulin-like growth factor 1;(5) neurotrophin 3;(6) interleukin-17 receptor C;(7) melatonin receptor 1B, and(8) Scoli Score test. Other predictors included:(1) impairment of melatonin signaling in osteoblasts and peripheral blood mononuclear cells(PBMC);(2) G-protein signaling dysfunction in PBMC; and(3) the level of platelet calmodulin. However, predictive values of all these findings were limited, and the levels of evidence were low. The pooled result of brace treatment outcomes demonstrated that around 27% of patents with AIS experienced exacerbation of the spine deformity during or after brace treatment, and 15% required surgical correction. However, the level of evidence is also low due to the limitations of the included studies.CONCLUSION: This review did not reveal any methods for the prediction of progression in AIS that could be recommended for clinical use as diagnostic criteria.

Increased Expression of Receptor Activator of Nuclear Factor-κB Ligand in Osteoblasts from Adolescent Idiopathic Scoliosis Patients with Low Bone Mineral Density

Persistent generalized low bone mineral density (BMD) has been reported in patients with adolescent idiopathic scoliosis (AIS).However,the exact mechanisms and causes of the low BMD in AIS patients are largely unknown.The purpose of this study was to examine the relationship between the receptor activator of NF-κB ligand (RANKL)/osteoprotegerin (OPG) levels in osteoblasts (OBs) from AIS patients with low BMD and with comparison made between the patients and controls.Twenty AIS patients and eight age-matched controls were included in the present study.The BMD of lumbar spine and proximal femur was measured in all subjects.OBs from the cancellous bone of each subject was harvested and primarily cultured.The mRNA and protein expression of RANKL and OPG in OBs was detected by RT-PCR and Western blotting.The results showed BMD was lower in AIS patients than in controls.A significantly higher mRNA and protein expression of RANKL was observed in OBs from AIS patients,while no significant difference was found in the expression of OPG between AIS patients and controls.As a result,RANKL/OPG ratio in patients with AIS was remarkably higher than controls.Our study preliminarily demonstrated expression of RANKL was higher in OBs from AIS patients with low BMD as compared with controls,suggesting the unbalanced RANKL/OPG ratio caused by an over-expression of RANKL in OBs may be responsible for the low BMD in AIS patients.

Altered physiology of mesenchymal stem cells in the pathogenesis of adolescent idiopathic scoliosis

Adolescent idiopathic scoliosis is the most common spinal deformity during puberty,especially in females.It is characterized by aberrant skeletal growth and generalized reduced bone density,which is associated with impaired bone mineral metabolism.Despite recent progress in multidisciplinary research to support various hypotheses,the pathogenesis of Adolescent idiopathic scoliosis is still not clearly understood.One of the hypothesis is to study the role of mesenchymal stem cells due to its involvement in the above-mentioned bone metabolic abnormalities.In this review,we will summarize reported literatures on the role of mesenchymal stem cells,particularly in the pathogenesis of Adolescent idiopathic scoliosis.In addition,we will describe the research on mesenchymal stem cells of Adolescent idiopathic scoliosis performed using bioinformatics tools.

POSTERIOR SELECTIVE THORACIC FUSION IN ADOLESCENT IDIOPATHIC SCOLIOSIS

To define the criteria of posterior selective thoracic fusion in patients with adolescent idiopathic scoliosis. Methods By reviewing the medical records and roentgenograms of 17 patients with adolescent idiopathic scoliosis who un-derwent posterior selective thoracic fusion, the curve type, Cobb angle, apical vertebral rotation and translation, trunk shift, and thoracolumbar kyphosis were measured and analyzed. Results There were 17 King type Ⅱ patients (PUMC type: Ⅱb1 13, Ⅱc3 4). The coronal Cobb angle of thoracic curve be-fore and after operation were 56.9°and 21.6° respectively, the mean correction rate was 60.1%. The coronal Cobb angle of lumbar curve before and after operation were 34.8° and 12.1° respectively, and the mean spontaneous correction rate was 64.8%. At final follow-up, the coronal Cobb angle of thoracic and lumbar curve were 23.5° and 15.2° respectively, there were no significant changes in the coronal Cobb angle, apical vertebral translation and rotation compared with that after operation. One patient had 12° of thoracolumbar kyphosis after operation, no progression was noted at final follow-up. There was no trunk decompensation or deterioration of the lumbar curve. In this group, 3.9 levels were saved compared with fusing both the th-oracic and lumbar curves. Conclusion Posterior selective thoracic fusion can be safely and effectively performed in King type Ⅱ patients with a mo-derate and flexible lumbar curve, which can save more mobile segments and at the same time can maintain a good coronal and sagittal balance.

Postoperative Disc Wedging in Adolescent Idiopathic Thoracolumbar/Lumbar Scoliosis:a Comparison of Anterior and Posterior Approaches

Objective To evaluate the different influences of anterior and posterior correction and fusion approaches upon disc wedging in adolescent idiopathic thoracolumbar/lumbar scoliosis.Methods The retrospective study was conducted with the medical records and radiographs of adolescent idiopathic thoracolumbar/lumbar scoliosis patients that underwent anterior(group A) or posterior(group B) correction and fusion surgery from December 1998 to May 2008.The correction of the main curve and changes of the disc wedging were analyzed.Results Fifty-three patients were included,26 in group A and 27 in group B.The mean coronal Cobb angles of the main curve in group A and group B were significantly corrected after surgery(P<0.05),with an average correction rate of 75.2% and 88.2%,respectively.Upon final follow-up,the coronal Cobb angles of the two groups were 18.9°±11.1° and 7.7°±5.6°,respectively,with an average correction loss of 6.8°±6.5° and 2.7°±3.3°,respectively.The coronal Cobb angle after operation and at final follow-up,and the correction rate were significantly better in group B than those in group A(P<0.05),while the coronal Cobb angle loss in group A was greater than that in group B(P<0.05).The disc wedging before operation,after operation,and at final follow-up were 3.2°±3.0°,5.7°±3.0°,and 8.6°±4.4° in group A,and 2.4°±3.2°,3.3°±3.4°,and 3.7°±3.6° in group B,respectively.Postoperative disc wedging was significantly larger compared with preoperative measurements in group A(P<0.05),but not in group B(P>0.05).The difference between disc wedging at final follow-up and that after surgery was significant in group A(P<0.05),but not in group B(P>0.05).Between the two groups,group A had larger disc angles after operation and at final follow-up(P<0.05),and a greater loss of disc angle(P<0.05).Conclusion For adolescent idiopathic thoracolumbar/lumbar scoliosis,posterior approach using all pedicle screws might produce a better result in terms of disc wedging compared with anterior approach.

Accuracy of pedicle screw placement in Lenke 1 adolescent idiopathic scoliosis surgery using intraoperative navigation with a simple calibration technique

Objective:To compare the position and the grade of screw perforation in Lenke 1 adolescent idiopathic scoliosis(AIS)surgery using intraoperative navigation system with and without calibration technique,and to explore the related factors of navigation deviation and the clinical significance of calibration technique.Methods:From 2014 to 2017,a total of 45 Lenke 1 AIS surgical cases were enrolled in this study.The 23 surgical cases were assisted with intraoperative navigation system(Navigation group)and another 22 cases received surgery using intraoperative navigation system with calibration technique(Calibration group).In two groups,the basic information and radiological data were all recorded.Postoperative CT scan with 3D reconstruction was used to analyze the accuracy of pedicle screw placement,as well as the length and position of cortical perforation.Results:There was no statistical difference between two groups in gender,age,Risser sign,both preoperative Cobb angles and flexibility of the major curve,as well as numbers of pedicle screws.477 and 469 pedicle screws were implanted in the navigation group and the calibration group respectively.The rate for major pedicle perforations 2 mm(grades 2,3)was 7.8%in navigation group.It was statistically significant difference from the 4.3%screw misplacement in calibration group(P=0.014).In navigation group,the rates of major pedicle perforations 2 mm were medial:3.4%,lateral:3.6%and anterior:0.6%respectively.The corresponding rates were 1.1%,2.6%and 0.4%in calibration group respectively.The rates of the medial cortical perforation 2 mm showed statistical difference between two groups(P=0.016).No serious complications,such as nerve or vascular injury,were found in all patients.Conclusion:Intraoperative navigation system with calibration technique provides the real-time monitoring of navigation deviation,the higher accuracy of pedicle screw insertion,the lower medial cortical perforation rate and the less complication rate,as well as a simple calibration technique with higher accuracy of screw placement in comparison to intraoperative navigation system for Lenke 1AIS surgery.

The Differential Effects of Exercise, Brace and Combined Rehabilitation Treatment in Patients with Adolescent Idiopathic Scoliosis

Objective:To compare the effects of different conservative managements on patients with adolescent idiopathic scoliosis (AIS). Method:One hundred and four AIS patients were recruited for this study. The patients were divided into 3 groups:exercise (E group), brace (B group) and combined rehabilitation treatment (brace treatment combined with exercise, CR group). Radiological parameter were used to assess AIS patients before and after treatment. The Chinese version of scoliosis research society-22(SRS-22) patient questionnaires were filled out by patients after treatment. The SRS-22 scores were compared among management groups. Result:The maximal Cobb angles were smaller in E group than in B group or CR group both before and af- ter treatment. The maximal Cobb angles were significantly smaller after treatment than before treatment in B group and CR group. Function/activity was better in E group than in B group or CR group. Self-image/appear- ance and satisfaction with management were better in E group and CR group than in B group. There was no significant difference among treatment groups in pain and mental health. Conclusion:Both brace and combined rehabilitation treatment can reduce the spinal curve of AIS patients. Both exercise and combined rehabilitation treatment have positive influence on self-image/appearance and satis- faction with management. We support preference of combined rehabilitation treatment above brace treatment.

Pedicle Screw Insertion for Concave Side of Proximal Thoracic Curve in Adolescent Idiopathic Scoliosis

Background: Insertion of the pedicle screws (PS) into the proximal thoracic spine is occasionally challenging owing to the small size of the pedicles and the proximity to the spinal cord. An appropriate anchor placement method for the concave side of the proximal thoracic curve has not been established yet. This study aimed to evaluate the pedicle size and position of PS on the concave side of the proximal thoracic curve in patients with adolescent idiopathic scoliosis (AIS). Methods: Forty consecutive patients with AIS who underwent correction and fusion with all PS constructs, including the proximal thoracic curve in the fusion area, were included. After identifying the screws inserted on the concave side of the proximal thoracic curve, the pre-operative morphology and postoperative position of the inserted PS, including the end vertebrae, were analyzed using computed tomography (CT). Screw perforations were categorized into four grades depending on the degree of perforation from the pedicle wall on postoperative CT and were classified using an outcome-based classification. Results: A total of 109 screws were inserted on the concave side of the proximal thoracic curve. The average width of all pedicles was 3.5 ± 1.1 mm. The width of 90 pedicles (83%) was Conclusion: Perforations were found in 84% of the PS on the concave side of the proximal thoracic curve;however, 93% of the PS were considered acceptable in the outcome-based classification. Thus, we conclude that the in-out-in technique may be both feasible and effective.

Research progress of the relationship between abnormal vestibular reflexes and adolescent idiopathic scoliosis

Adolescent idiopathic scoliosis (AIS) is an agnogenic structural scoliosis occurring in adolescence, and the main diagnostic criteria is coronal Cobb angle >10°in total spine X-ray. Studies have shown that AIS may be associated with abnormal postural reflexes, vestibular system is an important component of postural reflexes and its mechanism in the occurrence and development of scoliosis has received wide attention in recent years. In the study, the research progress on the role of abnormal vestibular reflexes in the pathogenesis of AIS was mainly introduced to help the clinicians better understand the pathogenesis of AIS and provide new ideas for AIS study.

上端融合椎的选择对Lenke 5C型特发性脊柱侧凸患者术后肩平衡的影响

目的评估Lenke 5C型青少年特发性脊柱侧凸(Adolescent idiopathic Scoliosis,AIS)上端融合椎(The upper instrumented vertebra,UIV)为上端椎(The upper end vertebra,UEV)和UEV+1对患者术后肩平衡的影响。方法回顾性分析2012年1月至2019年12月48例Lenke 5C型AIS患者的资料,所有患者均行后路矫形选择性胸腰椎融合术,根据UIV和UEV之间的关系,将UIV作为UEV的设定为UEV组,将UIV作为UEV+1的设定为UEV+1组,比较两组影像学参数和临床结果的异同。结果48例患者均随访2年以上,UEV组26例,UEV+1组22例。UEV+1组术后末次随访时TL/L矫正率明显高于UEV组(73.14%vs 63.71%,P<0.05),UIV倾斜度明显降低,影像学的肩高度差(RSH)绝对值显著增加(7.63 mm vs 0.72 mm,P<0.05),冠状面失衡绝对值显著增加(12.02 mm vs 4.81 mm,P<0.05)。UEV+1组术后肩失衡(RSH≥20 mm)发生率明显高于UEV组。两组在矢状位排列和患者预后方面差异无统计学意义(P>0.05)。结论当UIV选择为UEV+1时,TL/L矫正率提高,但增加了肩和冠状面失衡的风险,临床应尽可能选择UEV作为UIV,以维持AIS患者肩平衡。

青少年特发性脊柱侧凸患者术后早期离床活动的研究进展

青少年特发性脊柱侧凸行后路矫形融合术患者术后早期离床活动可促进呼吸、胃肠、肌肉骨骼等多系统功能恢复,有利于预防肺部感染、压力性损伤和下肢深静脉血栓形成。文章综述了青少年特发性脊柱侧凸患者术后早期离床活动的时机、内容、效果、影响因素、存在问题等研究进展,旨在为临床医护人员安全有效地指导青少年特发性脊柱侧凸患者术后早期离床活动及相关研究提供参考。

悬吊推拿运动技术在改善青少年特发性脊柱侧弯患者椎旁肌不对称性中的作用

目的探讨悬吊推拿运动技术在改善青少年特发性脊柱侧弯(AIS)患者椎旁肌不对称性中的作用。方法选取2021年10月—2023年8月于山东中医药大学第二附属医院康复科就诊并符合纳入标准的AIS患者88例作为研究对象,采用随机数字表法分为对照组和试验组,每组44例。对照组参照德国Schroth脊柱侧弯三维矫正疗法进行常规康复训练,包括手法放松侧弯凹侧椎旁肌肌肉,“臀桥”“小燕飞”力量练习,施罗特体操包括“肌肉圆柱”“旋转坐位运动”“伸展运动”配合成角呼吸。试验组运用悬吊推拿运动技术治疗,主要包括在悬吊设备辅助下调节脊柱位置恢复脊柱中立位,以弹拨、按推等推拿手法往返作用于督脉、膀胱经行整体治疗和凸凹侧椎旁辨证补泻治疗,仰卧位、俯卧位和侧卧位的中立位控制训练,躯干屈伸、旋转、侧屈闭链运动训练。在治疗前和治疗4周后运用肌电生物反馈仪测量患者站立负重时椎旁肌的表面肌电图(sEMG),通过自带软件进行分析,采集均方根(RMS),并计算椎旁肌肉对称指数(PMSI=RMS凸/RMS凹);采用Cobb角评估患者脊柱侧弯的严重程度;采用躯干旋转角度(ATR)评估躯干的旋转程度、脊柱的功能和形态。结果治疗前,2组PMSI值、Cobb角、ATR值比较,差异均无统计学意义(P>0.05)。治疗4周后,试验组PMSI值为1.08(1.04,1.14),Cobb角为5(2,9)°,ATR值为2(1,3)°;对照组PMSI值为1.12(1.09,1.17),Cobb角为8.5(6,10)°,ATR值为2(2,3)°。组内比较,治疗后2组PMSI值均更接近1(P<0.05),Cobb角、ATR值均下降(P<0.05)。组间比较,治疗后试验组PMSI值、Cobb角改善效果均优于对照组,试验组PMSI值更接近1(P<0.05),Cobb角明显更低(P<0.05),但治疗后2组ATR值差异无统计学意义(P>0.05)。结论悬吊推拿运动技术可有效改善椎旁肌不对称性,达到降低患者的Cobb角的矫形目的,值得临床推广应用。

超声下探究功能性训练对青少年特发性脊柱侧弯患者脊柱周围肌肉形态的影响

目的应用超声检测顶锥周围肌肉厚度变化探讨1个月的功能性训练对青少年特发性脊柱侧弯(AIS)患者脊柱周围肌肉形态的影响。方法选取昆明市中医医院康复科2022年8月—2023年3月收治的30例AIS患者为研究对象,进行1个月的功能性训练,治疗前、后均测量Cobb角,通过超声检测顶锥周围肌肉厚度,比较治疗前后的变化情况。结果训练1个月后,30例患者的顶锥左、右侧肌群厚度均厚于训练前,左右两侧肌肉厚度差小于训练前,差异有统计学意义(P<0.05);30例患者的Cobb角小于训练前,差异无统计学意义(P>0.05)。结论1个月的功能训练可增加AIS患者脊柱左右两侧肌肉厚度,缩小左右两侧肌肉厚度差,改善AIS患者脊柱周围肌肉形态;脊柱周围肌肉形态检测配合脊柱全长片对脊柱侧弯的早期治疗具有指导意义。

骨粘连蛋白促骨髓来源间充质干细胞成骨分化在青少年特发性脊柱侧凸中的作用

目的探究骨骼肌分泌的骨粘连蛋白(Osteonectin)促骨髓来源间充质干细胞(BMSC)成骨分化在青少年特发性脊柱侧凸(AIS)中的作用。方法纳入30例AIS患者,根据X射线片测量的Cobb角,将其分为轻度AIS组和重度AIS组。比较2组患者腰椎和骨骼肌骨密度(BMD)。收集2组患者BMSC,通过流式细胞术检测CD73和CD90蛋白表达,qRT-PCR检测Runx2、Osterix和Osteocalcin mRNAs表达水平,ELISA检测碱性磷酸酶(ALP)活性。收集2组患者骨骼肌,检测Osteonectin mRNA和蛋白表达水平。ELISA检测2组患者血清中Osteonectin水平。体外培养BMSC,分为BMSC组(无特殊处理)和BMSC+Osteonectin组(添加Osteonectin),检测Runx2、Osterix和Osteocalcin mRNAs表达水平及ALP活性。结果与轻度AIS组比较,重度AIS组患者腰椎和骨骼肌BMD降低(P<0.05),BMSC中Runx2、Osterix和Osteocalcin mRNAs表达水平降低(P<0.05),ALP活性降低(P<0.05);骨骼肌中Osteonectin mRNA和蛋白表达水平降低(P<0.05);血清中Osteonectin水平降低(P<0.05)。与BMSC组比较,BMSC+Osteonectin组细胞Runx2、Osterix和Osteocalcin mRNAs表达水平升高(P<0.05),ALP活性升高(P<0.05)。结论AIS患者骨骼肌分泌Osteonectin减少,BMSC的成骨分化能力降低。外源性补充Osteonectin可改善BMSC的成骨分化能力,可能有助于AIS病情的恢复。

Osteonectin促进骨髓来源间充质干细胞成骨分化的机制及其与青少年特发性脊柱侧凸的相关性研究

目的 探究Osteonectin在促进骨髓间充质干细胞(BMSCs)成骨分化的分子机制,以及Osteonectin在青少年特发性脊柱侧凸(AIS)中的作用。方法 将2020年5月—2022年5月就诊的20例AIS及健康体检20例分别作为AIS组和健康组。使用qRT-PCR技术测定2组BMSCs中Osteonectin、BMP2以及Wnt/β-catenin信号通路相关基因(Tcf7、Lef1)和成骨分化相关基因(Runx2、Osteocalcin)的表达水平。通过X线检测AIS患者的Cobb角度,并分析上述基因表达水平与Cobb角度的相关性。在BMSCs中,加入Osteonectin和BMP2抑制剂Noggin,并分为对照组、Osteonectin组和Osteonectin+Noggin组。通过qRT-PCR检测BMSCs中BMP2、Tcf7、Lef1、Runx2和Osteocalcin mRNA表达水平。采用ChIP-qPCR检测β-catenin在Runx2和Osteocalcin基因转录起始位(TSS)的富集水平。结果 与健康组比较,AIS组BMSCs中Osteonectin、BMP2、Tcf7、Lef1、Runx2和Osteocalcin mRNA表达水平均降低(P<0.05);Osteonectin、BMP2、Tcf7、Lef1、Runx2和Osteocalcin mRNA表达水平与AIS患者Cobb角度呈负相关(r=-0.466 3、-0.369 1、-0.272 7、-0.543 4、-0.606 5、-0.343 3,P<0.05,P<0.01)。与对照组比较,Osteonectin组BMSCs中BMP2、Tcf7、Lef1、Runx2和Osteocalcin mRNA表达水平升高,且β-catenin在Runx2和Osteocalcin mRNA TSS富集水平增加(P<0.05)。相比Osteonectin组,Osteonectin+Noggin组BMSCs中Tcf7、Lef1、Runx2和Osteocalcin mRNA表达水平降低,β-catenin在Runx2和Osteocalcin mRNA TSS富集水平降低(P<0.05)。结论 在AIS患者中,BMSCs中Osteonectin、BMP2-Wnt/β-catenin的表达以及成骨分化水平与AIS疾病的发展呈负相关。Osteonectin通过激活BMP2-Wnt/β-catenin信号通路,促使β-catenin转录激活成骨分化相关基因,从而促进BMSCs的成骨分化。